The most common malignant lesions on the facial skin consist of basal cell, squamous cell carcinomas, and melanomas; Other but rarer lesions can be found, such as keratoacanthoma, Merkel cell tumour, and sweat gland carcinoma. That is why we can extrapolate this frequency of appearance of tumour types to the nasal skin, the area of the face that we treat in this article regarding a case of recurrent squamous cell carcinoma that required total nasal amputation and subsequent reconstruction.
In the event that direct closure cannot be performed after simple ellipse excision, due to the creation of a larger surgical defect, we will have to opt for an adequate full-thickness reconstruction. Local flaps from the immediate vicinity of the defect are the most desirable, both from a functional and aesthetic point of view. The blood supply to the skin and facial soft tissues is extremely rich since the terminal branches of the external carotid artery provide a good supply. Flaps on the face can be based on random vascularization (rhomboid, bilobed and banner) or on axial vascularization (nasolabial, glabellar, frontal …).
Metastatic spread to regional lymph nodes from primary malignant neoplasms of the scalp and face is rare. In general, squamous cell carcinomas less than 2 cm in diameter carry an extremely low risk of metastasis; therefore, planned treatment of regional lymph nodes is not recommended. Lesions larger than 2 cm have a proportionally higher risk of regional lymphatic spread. In general, planned regional lymph node dissection does not offer significant therapeutic benefits. A slight improvement in prognosis is seen with scheduled regional lymph node dissection for intermediate-thickness malignant melanomas of skin origin.